AU2008249243B2 - Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram - Google Patents
Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram Download PDFInfo
- Publication number
- AU2008249243B2 AU2008249243B2 AU2008249243A AU2008249243A AU2008249243B2 AU 2008249243 B2 AU2008249243 B2 AU 2008249243B2 AU 2008249243 A AU2008249243 A AU 2008249243A AU 2008249243 A AU2008249243 A AU 2008249243A AU 2008249243 B2 AU2008249243 B2 AU 2008249243B2
- Authority
- AU
- Australia
- Prior art keywords
- complex fractionated
- locations
- area
- interest
- electrograms
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Ceased
Links
- 230000001746 atrial effect Effects 0.000 title description 8
- 210000000609 ganglia Anatomy 0.000 title description 3
- 238000000034 method Methods 0.000 claims description 26
- 238000013507 mapping Methods 0.000 claims description 19
- 230000000694 effects Effects 0.000 claims description 16
- 230000009467 reduction Effects 0.000 claims description 8
- 230000000638 stimulation Effects 0.000 claims description 8
- 230000002159 abnormal effect Effects 0.000 claims description 7
- 230000004044 response Effects 0.000 claims description 7
- 208000010496 Heart Arrest Diseases 0.000 claims description 4
- 230000036772 blood pressure Effects 0.000 claims description 4
- 230000002526 effect on cardiovascular system Effects 0.000 claims description 4
- 238000012790 confirmation Methods 0.000 claims description 3
- 230000004936 stimulating effect Effects 0.000 claims description 3
- 210000005242 cardiac chamber Anatomy 0.000 abstract description 10
- 241000894007 species Species 0.000 description 32
- 238000002679 ablation Methods 0.000 description 12
- 206010003658 Atrial Fibrillation Diseases 0.000 description 7
- 230000000747 cardiac effect Effects 0.000 description 6
- 230000004913 activation Effects 0.000 description 5
- 230000033001 locomotion Effects 0.000 description 5
- 206010003119 arrhythmia Diseases 0.000 description 4
- 210000005003 heart tissue Anatomy 0.000 description 4
- 210000003492 pulmonary vein Anatomy 0.000 description 4
- 210000001519 tissue Anatomy 0.000 description 4
- 238000010586 diagram Methods 0.000 description 3
- 230000005672 electromagnetic field Effects 0.000 description 3
- 210000002837 heart atrium Anatomy 0.000 description 3
- 238000002955 isolation Methods 0.000 description 3
- 210000005245 right atrium Anatomy 0.000 description 3
- 230000001225 therapeutic effect Effects 0.000 description 3
- 238000013459 approach Methods 0.000 description 2
- 230000008901 benefit Effects 0.000 description 2
- 229910003460 diamond Inorganic materials 0.000 description 2
- 239000010432 diamond Substances 0.000 description 2
- 230000006870 function Effects 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000008569 process Effects 0.000 description 2
- 230000033764 rhythmic process Effects 0.000 description 2
- 239000000523 sample Substances 0.000 description 2
- 230000002792 vascular Effects 0.000 description 2
- 206010001497 Agitation Diseases 0.000 description 1
- 238000010317 ablation therapy Methods 0.000 description 1
- 230000009471 action Effects 0.000 description 1
- 230000006793 arrhythmia Effects 0.000 description 1
- 230000003126 arrythmogenic effect Effects 0.000 description 1
- 230000002567 autonomic effect Effects 0.000 description 1
- 210000000467 autonomic pathway Anatomy 0.000 description 1
- 238000004590 computer program Methods 0.000 description 1
- 230000002950 deficient Effects 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 238000001514 detection method Methods 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 238000006073 displacement reaction Methods 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 230000007717 exclusion Effects 0.000 description 1
- 238000010438 heat treatment Methods 0.000 description 1
- 230000001939 inductive effect Effects 0.000 description 1
- 238000003780 insertion Methods 0.000 description 1
- 230000037431 insertion Effects 0.000 description 1
- 230000002045 lasting effect Effects 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 230000003278 mimic effect Effects 0.000 description 1
- 210000004165 myocardium Anatomy 0.000 description 1
- 230000001537 neural effect Effects 0.000 description 1
- 230000037361 pathway Effects 0.000 description 1
- 230000002085 persistent effect Effects 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 230000029058 respiratory gaseous exchange Effects 0.000 description 1
- 230000001954 sterilising effect Effects 0.000 description 1
- 238000004659 sterilization and disinfection Methods 0.000 description 1
- 239000000758 substrate Substances 0.000 description 1
- 230000002459 sustained effect Effects 0.000 description 1
- 238000002604 ultrasonography Methods 0.000 description 1
- 230000001515 vagal effect Effects 0.000 description 1
- 230000000007 visual effect Effects 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/346—Analysis of electrocardiograms
- A61B5/349—Detecting specific parameters of the electrocardiograph cycle
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
- A61B5/0265—Measuring blood flow using electromagnetic means, e.g. electromagnetic flowmeter
- A61B5/027—Measuring blood flow using electromagnetic means, e.g. electromagnetic flowmeter using catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/25—Bioelectric electrodes therefor
- A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
- A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
- A61B5/283—Invasive
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/339—Displays specially adapted therefor
- A61B5/341—Vectorcardiography [VCG]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00839—Bioelectrical parameters, e.g. ECG, EEG
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7203—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
- A61B5/7207—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal of noise induced by motion artifacts
- A61B5/721—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal of noise induced by motion artifacts using a separate sensor to detect motion or using motion information derived from signals other than the physiological signal to be measured
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Cardiology (AREA)
- Physics & Mathematics (AREA)
- Animal Behavior & Ethology (AREA)
- Molecular Biology (AREA)
- Veterinary Medicine (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Public Health (AREA)
- Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Physiology (AREA)
- Electromagnetism (AREA)
- Hematology (AREA)
- Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
- Surgical Instruments (AREA)
Abstract
Software and apparatus are provided to automatically detect and map ganglionated plexi that are found within areas of complex fractionated electrograms in cardiac chambers. Electrogram signal are analyzed to count the number of complexes whose amplitude and peak-to-peak intervals meet certain criteria. Functional maps indicating a spatial distribution of the ganglionated plexi and the relative numbers of complex fractionated electrograms are produced for display. 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc, 1
Description
- 1 DETERMINING LOCATIONS OF GANGLIA AND PLEXI IN THE HEART USING COMPLEX FRACTIONATED ATRIAL ELECTROGRAM CROSS-REFERENCE TO RELATED APPLICATIONS [00011 This Application claims priority of U.S. Provisional Application No. 60/990,961, entitled "Determining Locations of Ganglia Plexus (GP) Areas in the Heart Using CFAE", filed November 29, 2007, and U.S. Patent Application Serial No. 12/275,380, filed November 21, 2008, which are herein incorporated by reference. This Application shares disclosure with U.S. Patent Application Serial No. 11/620,370, entitled "Mapping of Complex Fractionated Atrial Electrogram", filed January 5, 2007. BACKGROUND OF THE INVENTION Field of the Invention [00021 This invention relates to the diagnosis and treatment of cardiac arrhythmias. More particularly, this invention relates to the mapping of ganglionated neural plexi in the heart that are associated with arrhythmogenic areas. Description of the Related Art [0003] The meanings of certain acronyms and abbreviations used herein are given in Table 1. Table 1 - Acronyms and Abbreviations GP Ganglionated Plexi AF Atrial Fibrillation CFAE Complex Fractionated Atrial Electrogram [0004] Cardiac arrhythmias such as atrial fibrillation are an important cause of morbidity and death. Commonly assigned U.S. Patent No. 5,546,951, and U.S. Patent No. 6,690,963, both issued to Ben Haim; and PCT application WO 96/05768, 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc, I -2 all of which are incorporated herein by reference, disclose methods for sensing an electrical property of heart tissue, for example, local activation time, as a function of the precise location within the heart. Data are acquired with one or more catheters having electrical and location sensors in their distal tips, which are advanced into the heart. Methods of creating a map of the electrical activity of the heart based on these data are disclosed in commonly assigned U.S. Patent No. 6,226,542, and U.S. Patent No. 6,301,496, both issued to Reisfeld, which are incorporated herein by reference. As indicated in these patents, location and electrical activity is typically initially measured on about 10 to about 20 points on the interior surface of the heart. These data points are then generally sufficient to generate a preliminary reconstruction or map of the cardiac surface. The preliminary map is often combined with data taken at additional points in order to generate a more comprehensive map of the heart's electrical activity. Indeed, in clinical settings, it is not uncommon to accumulate data at 100 or more sites to generate a detailed, comprehensive map of heart chamber electrical activity. The generated detailed map may then serve as the basis for deciding on a therapeutic course of action, for example, tissue ablation, to alter the propagation of the heart's electrical activity and to restore normal heart rhythm. [0005] Catheters containing position sensors may be used to determine the trajectory of points on the cardiac surface. These trajectories may be used to infer motion characteristics such as the contractility of the tissue. As disclosed in U.S. Patent No. 5,738,096, issued to Ben Haim, which is incorporated herein in its entirety by reference, maps depicting such motion characteristics may be constructed when the trajectory information is sampled at a sufficient number of points in the heart. [0006] Electrical activity at a point in the heart is typically measured by advancing a catheter containing an electrical sensor at or near its distal tip to that point in the heart, contacting the tissue with the sensor and acquiring data at that point. One drawback with mapping a cardiac chamber using a catheter containing only a single, distal tip electrode is the long period of time required to accumulate data on a point-by-point basis over the requisite number of points required for a 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,2 -3 detailed map of the chamber as a whole. Accordingly, multiple-electrode catheters have been developed to simultaneously measure electrical activity at multiple points in the heart chamber. [0007] Over the past decade, several mapping studies in human atrial fibrillation have made the following important observations. Atrial electrograms during sustained atrial fibrillation have three distinct patterns: single potential, double potential and a complex fractionated atrial electrograms (CFAE's). The CFAE areas represent the atrial fibrillation substrate sites and become important target sites for ablation. By ablating areas having persistent CFAE's, atrial fibrillation may be eliminated and even rendered non-inducible. [0008] In the document Ganglionated Plexi Modulate Extrinsic Cardiac Autonomic Nerve Input, Hou et al., Journal of the American College of Cardiology Vol. 50, No. 1, 2007, it is suggested that ablation of the four left atrial autonomic ganglionated plexi (GP) can improve success of ablation procedures for the treatment of atrial fibrillation. The authors used high frequency stimulation to locate the ganglionated plexi for this purpose. High frequency stimulation, however, is cumbersome and time consuming, requiring special equipment and skills. SUMMARY OF THE INVENTION [0009] According to one aspect of the present invention there is provided a method for mapping abnormal electrical activity in a heart of a living subject, comprising the steps of: obtaining electrical signal data from respective locations of the heart in an area of interest; automatically analyzing the signal data to identify complex fractionated electrograms or complex fractionated electrogram segments therein; determining if the number of identified complex fractionated electrograms in the area of interest exceed a predetermined threshold for complex fractionated electrograms or if the number of complex fractionated electrogram segments in the area of interest achieve a maximal number; 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,3 -4 identifying one or more of the locations in the area of interest as having ganglionated plexi if the number of identified complex fractionated electrograms in the area of interest exceeded the predetermined threshold for complex fractionated electrograms or if the number of complex fractionated electrogram segments in the area of interest achieved the maximal number; deriving an electroanatomic map of the heart from the signal data that includes a spatial distribution of the complex fractionated electrograms and the ganglionated plexi, the electroanatomical map including a key encoding the number of complex fractionated electrograms in any area of interest; and displaying the spatial distribution of the complex fractionated electrograms and the ganglionated plexi with the key encoding the number of complex fractionated electrograms in any area of interest of the electroanatomic map. [0010] Preferably, identifying one or more of the locations includes determining that a number of the complex fractionated electrograms at the one or more of the locations complies with a predefined criterion. [00111 Preferably, compliance with the predefined criterion includes identifying at least a threshold number of the complex fractionated electrograms at a location. [0012] Preferably, compliance with the predefined criterion includes identifying ones of the locations having locally maximal numbers of complex fractionated electrograms. [0013] Preferably the method further comprises the steps of: electrically stimulating selected locations that presumptively contain ganglionated plexi, and then recording a cardiovascular response including at least one of: a reduction in sinus rate, a reduction in blood pressure, and a period of asystole, and thereafter reporting a confirmation of a presence of the ganglionated plexi in the selected locations. 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,4 -5 [0014] Preferably, deriving an electroanatomic map includes coding the electroanatomic map according to numbers of the complex fractionated electrograms detected in the respective locations. [0015] According to a further aspect of the present invention there is provided an apparatus for mapping electrical activity in a heart of a living subject, comprising: a memory for storing electrical signal data from respective locations in an area of interest of the heart; a processor configured to access the memory and automatically analyze the signal data to identify complex fractionated electrograms or complex fractionated electrogram segments in the area of interest, and to determine when the number of identified complex fractionated electrograms in the area of interest exceed a predetermined threshold for complex fractionated electrograms or when the number of complex fractionated electrogram segments in the area of interest achieve a maximal number, and identify one or more of the area of interests as having ganglionated plexi when the number of identified complex fractionated electrograms in the area of interest exceeded the predetermined threshold for complex fractionated electrograms or when the number of complex fractionated electrogram segments in the area of interest achieved the maximal number; an electroanatomic map of the heart is derived from the signal data that includes a spatial distribution of the complex fractionated electrograms and the ganglionated plexi, the electroanatomical map including a key encoding the number of complex fractionated electrograms in any area of interest; and a display for presenting the electroanatomic map to an operator. BRIEF DESCRIPTION OF THE DRAWINGS [00161 For a better understanding of the present invention, reference is made to the detailed description of the invention, by way of example, which is to be read in conjunction with the following drawings, wherein like elements are given like reference numerals, and wherein: 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,5 -6 [0017] Fig. 1 is a pictorial illustration of a system for detecting areas of abnormal electrical activity and performing ablative procedures on a heart of a living subject in accordance with a disclosed embodiment of the invention; [0018] Fig. 2 is a diagram of an embodiment of a catheter for use in the system shown in Fig. 1; [00191 Fig. 3 is a diagram depicting the distal end of a catheter in contact with the endocardial surface of the right atrium of a heart, in accordance with a disclosed embodiment of the invention; [00201 Fig. 4 is a functional electroanatomical map in the postero-anterior projection, showing CFAE's and ganglionated plexi, in accordance with a disclosed embodiment of the invention; and [00211 Fig. 5 is a functional electroanatomical map in the right anterior oblique projection, showing CFAE's and ganglionated plexi, in accordance with a disclosed embodiment of the invention. DETAILED DESCRIPTION OF THE INVENTION [0022] In the following description, numerous specific details are set forth in order to provide a thorough understanding of the various principles of the present invention. It will be apparent to one skilled in the art, however, that not all these details are necessarily always needed for practicing the present invention. In this instance, well-known circuits, control logic, and the details of computer program instructions for conventional algorithms and processes have not been shown in detail in order not to obscure the general concepts unnecessarily. [0023] Aspects of the present invention may be embodied in software programming code, which is typically maintained in permanent storage, such as a computer readable medium. In a client/server environment, such software programming code may be stored on a client or a server. The software programming code may be embodied on any of a variety of known tangible media for use with a data processing system, such as a diskette, hard drive, or CD-ROM. The code may be distributed on such media, or may be distributed to users from the memory or storage of one computer system over a network of some type to storage devices on other computer systems for use by users of such other systems. 18/07/13,M:\Grabam\Clare\Speci & Amndmts\17649 Speci.Doc,6 -7 System Architecture [00241 Turning now to the drawings, reference is initially made to Fig. 1, which is a pictorial illustration of a system 10 for detecting areas of abnormal electrical activity and performing ablative procedures on a heart 12 of a living subject 21 in accordance with a disclosed embodiment of the invention. The system comprises a probe, typically a catheter 14, which is percutaneously inserted by an operator 16, who is typically a physician, through the patient's vascular system into a chamber or vascular structure of the heart. The operator 16 brings the catheter's distal tip 18 into contact with the heart wall at a target site that is to be evaluated. Electrical activation maps are then prepared, according to the methods disclosed in the above-noted U.S. Patent Nos. 6,226,542, and 6,301,496, and in commonly assigned U.S. Patent No. 6,892,091, whose disclosure is herein incorporated by reference. [00251 Areas determined to be abnormal by evaluation of the electrical activation maps can be ablated application of thermal energy, e.g., by passage of radiofrequency electrical current through wires in the catheter to one or more electrodes at the distal tip 18, which apply the radiofrequency energy to the myocardium. The energy is absorbed in the tissue, heating it to a point (typically about 50 0 C) at which it permanently loses its electrical excitability. When successful, this procedure creates non-conducting lesions in the cardiac tissue, which disrupt the abnormal electrical pathway causing the arrhythmia. Alternatively, other known methods of applying ablative energy can be used, e.g., ultrasound energy, as disclosed in U.S. Patent Application Publication No. 2004/0102769, whose disclosure is herein incorporated by reference. The principles of the invention are disclosed with respect to atrial complex fractionated electrograms, but can be applied to all heart chambers, to epicardial as well as endocardial approaches, and to mapping in sinus rhythm, and when many different cardiac arrhythmias are present. [0026] The catheter 14 typically comprises a handle 20, having suitable controls on the handle to enable the operator 16 to steer, position and orient the distal 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,7 -8 end of the catheter as desired to the ablation. To aid the operator 16, the distal portion of the catheter 14 contains position sensors (not shown) that provide signals to a positioning processor 22, located in a console 24. The catheter 14 may be adapted, mutatis mutandis, from the ablation catheter described in commonly assigned U.S. Patent No. 6,669,692, whose disclosure is herein incorporated by reference. The console 24 typically contains an ablation power generator 43. [00271 The positioning processor 22 is an element of a positioning subsystem 26 that measures location and orientation coordinates of the catheter 14. Throughout this patent application, the term "location" refers to the spatial coordinates of the catheter, and the term "orientation" refers to its angular coordinates. The term "position" refers to the full positional information of the catheter, comprising both location and orientation coordinates. [0028] In one embodiment, the positioning subsystem 26 comprises a magnetic position tracking system that determines the position and orientation of the catheter 14. The positioning subsystem 26 generates magnetic fields in a predefined working volume its vicinity and senses these fields at the catheter. The positioning subsystem 26 typically comprises a set of external radiators, such as field generating coils 28, which are located in fixed, known positions external to the patient. The coils 28 generate fields, typically electromagnetic fields, in the vicinity of the heart 12. [0029] In an alternative embodiment, a radiator in the catheter 14, such as a coil, generates electromagnetic fields, which are received by sensors (not shown) outside the patient's body. [00301 Some position tracking systems that may be used for this purpose are described, for example, in the above-noted U.S. Patents 6,690,963, and in commonly assigned U.S. Patent Nos. 6,618,612 and 6,332,089, and U.S. Patent Application Publications 2004/0147920, and 2004/0068178, whose disclosures are all incorporated herein by reference. Although the positioning subsystem 26 shown in 1 8 /0 7 /13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,8 -9 Fig. 1 uses magnetic fields, the methods described below may be implemented using any other suitable positioning subsystem, such as systems based on electromagnetic fields, acoustic or ultrasonic measurements. [0031] Reference is now made to Fig. 2, which is a diagram of an embodiment of the catheter 14 for use in the system 10 (Fig. 1). The catheter 14 is a mapping and therapeutic delivery catheter for insertion into the human body, and into a chamber of the heart 12 (Fig. 1). The catheter shown is exemplary; many other types of catheters can be used as the catheter 14. The catheter 14 includes a body 30. An electrode 32 is at a distal portion 34 disposed for measuring the electrical properties of the heart tissue. The electrode 32 is also useful for sending electrical signals to the heart for diagnostic purposes, e.g., for electrical mapping, and/or for therapeutic purposes, e.g., for ablating defective cardiac tissue. The distal portion 34 further includes an array 36 of non-contact electrodes 38 for measuring far field electrical signals in the heart chamber. The array 36 is a linear array in that the non contact electrodes 38 are linearly arranged along the longitudinal axis of the distal portion 34. The distal portion 34 further includes at least one position sensor 40 that generates signals used to determine the position and orientation of the distal tip 18 within the body. The position sensor 40 is preferably adjacent to the distal tip 18. There is a fixed positional and orientational relationship of the position sensor 40, the distal tip 18 and the electrode 32. [0032] The position sensor 40 transmits, in response to the fields produced by the positioning subsystem 26 (Fig. 1), position-related electrical signals over a cable 42 running through the catheter 14 to the console 24. Alternatively, the position sensor 40 in the catheter 14 may transmit signals to the console 24 over a wireless link, as described in U.S. Patent Application Publication Nos. 2003/0120150 and 2005/0099290, the disclosures of which are herein incorporated by reference. The positioning processor 22 then calculates the location and orientation of the distal portion 34 of the catheter 14 based on the signals sent by the position sensor 40. The positioning processor 22 typically receives, amplifies, filters, digitizes, and otherwise processes signals from the catheter 14. The positioning processor 22 also provides a 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,9 -10 signal output to a display 44 that provides a visual indication of the position of the distal portion 34 and/or the distal tip 18 of the catheter 14 relative to the site chosen for ablation. [0033] The handle 20 of the catheter 14 includes controls 46 to steer or deflect the distal portion 34, or to orient it as desired. [0034] The cable 42 comprises a receptacle 48, which connects to the handle 20. The receptacle 48 is preferably configured to receive catheters of a specific model, and preferably includes user-evident identification of the specific model. One of the advantages in using the cable 42 is the ability to connect different models and types of catheters, such as those catheters having different handle configurations, to the same console 24 (Fig. 1). Another advantage in having a separate cable 42 is in the fact that it does not come into contact with patients, so that it is possible to reuse the cable 42 without sterilization. The cable 42 further contains one or more isolation transformers (not shown), which electrically isolate the catheter 14 from the console 24. The isolation transformers may be contained in the receptacle 48. Alternatively, isolation transformers may be contained in the system electronics of the console 24. [0035] Referring again to Fig. 1, the system 10 can be realized as the CARTO XP EP Navigation and Ablation System, available from Biosense Webster, Inc., 3333 Diamond Canyon Road, Diamond Bar, CA 91765, and suitably modified to execute the procedures described herein. Electrical Mapping [0036] Using the system 10 (Fig. 1), an electrical activation map of a chamber of the heart 12 can be generated using the methods described in the above noted U.S. Patent No. 6,892,091. A summary of one of these methods, modified according to the aspects of the present invention, will facilitate an understanding of the invention. Reference is now made to Fig. 3, which depicts the distal end of the catheter 14 in contact with an endocardial surface 50 of the right atrium 52 of the 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,10 - 11 heart 12, in accordance with a disclosed embodiment of the invention. The electrode 32 is maintained in contact with the endocardial surface 50 at a current contact point 54 throughout at least an entire cardiac cycle. During this time, location information is continuously measured by the position sensor 40 (Fig. 2), while electrical information, preferably, voltage (as a function of time), is measured by the electrode 32 and each of the non-contact electrodes 38 in the array 36 (Fig. 2). [00371 After the above electrical and location information is collected at the contact point 54, the electrode 32 is contacted with another contact point, e.g., a contact point 56 elsewhere on the endocardial surface of the right atrium 52. Points 58, shown as asterisks, represent the locations of the non-contact electrodes 38 while the electrode 32 was in contact with the contact point 54. [00381 The electrode 32 is advanced over a plurality of contact points on the cardiac chamber's endocardial surface. Location and electrical information is acquired while the contact electrode is in contact with each of the contact points. Typically, the above-described contacting and information acquisition steps are effected at between 5-15 such contact points. Since there are multiple non-contact electrodes 38, the total number of points used to acquire data in a chamber may be 160 points or more. The resultant location and electrical information acquired from the electrode 32 and the non-contact electrodes 38 at each of acquisition step provides the basis for generating an electrical map of the heart chamber. [00391 The location of the contact electrodes at each of the contact points may be used to define the geometric map of the cardiac chamber. While not actually contacting the cardiac surface, the totality of the non-contact electrode locations defines a "cloud" of space, which represents a minimum chamber volume. These non-contact locations may be used, alternatively, or together with the location of the electrode 32 at each of the contact points, to define the chamber geometry. [0040] It is preferable to use a reference location sensor to correct for patient movement during the procedure or to movement of the heart due to patient breathing. 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc, 11 - 12 One method of obtaining a location reference is by the use of a reference catheter (not shown) containing a reference location sensor elsewhere in the heart. Alternatively, a reference location sensor may be contained in a pad that might be attached external to the patient, for example on the back of the patient. In either case, locations determined by the sensors contained in the mapping catheter may be corrected for patient movement with the reference sensors. 10041] A preferred method for generating the electrical map of the heart from the acquired location and electrical information is described in the above noted U.S. Patent No. 6,226,542. Briefly, an initial, generally arbitrary, closed 3-dimensional curved surface (also referred to herein for brevity as a curve) is defined in a reconstruction space in the volume of the sampled points. The closed curve is roughly adjusted to a shape, which resembles a reconstruction of the sampled points. Thereafter, a flexible matching stage is preferably repeatedly performed one or more times in order to bring the closed curve to accurately resemble the shape of the actual volume being reconstructed. The 3-dimensional surface may be rendered to a video display or other screen for viewing by a physician or other user of the map. [0042] The initial closed curved surface preferably encompasses substantially all the sampled points or is interior to substantially all the sampled points. However, it is noted that any curve in the vicinity of the sampled points is suitable. Preferably, the closed three-dimensional curved surface comprises an ellipsoid, or any other simple closed curve. Alternatively, a non-closed curve may be used, for example, when it is desired to reconstruct a single wall rather than the entire volume. [0043] A grid of a desired density is defined on the curve. For each of the points on the grid, a vector is defined, which is dependent on the displacement between one or more of the grid points and one or more of the measured locations on the cardiac surface. The surface is adjusted by moving each of the grid points in response to the respective vector, so that the reconstructed surface is deformed to resemble the actual configuration of the cardiac chamber. The grid preferably divides the curved surface into quadrilaterals or any other polygons such that the grid evenly 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,12 - 13 defines points on the curve. Preferably, the grid density is sufficient such that there are generally more grid points than sampled points in any arbitrary vicinity. Further preferably, the grid density is adjustable according to a desired compromise between reconstruction accuracy and speed. CFAE Identification [0044] Automatic detection of CFAE's is described in detail in the above noted copending Application No. 11/620,370. However, a brief discussion here will facilitate understanding of some aspects of the present invention. CFAE's are nominally defined as areas that exhibit one of the following characteristics. In practice, a user or operator may vary these characteristics according to his experience and judgment with respect to a particular patient: (1) areas of the atrium that have fractionated electrograms composed of two deflections or more and/or perturbation of the baseline with a continuous deflection of a prolonged activation complex over a 10-sec recording period; or (2) areas of the atrium where the electrogram has a very short cycle length (e.g., 120 ms) averaged over a 10 second recording period. The recording period is not critical, and recording intervals of other lengths may be used. [0045] In aspects of the current embodiment the number of intervals between complexes is represented. However, this not limiting, and other types of information derived from data manipulation may form a basis for representing the number and characteristics of complexes. [0046] In order to identify CFAE's, fractionated complex duration mapping tools were constructed as a modification of the system software of the above-noted CARTO XP EP Navigation and Ablation System. Although the software is described with reference to this particular system, the invention is not limited to the CARTO XP EP Navigation and Ablation System, but can be applied to many other electrical mapping systems by those skilled in the art. 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,13 - 14 10047] The following parameters were used to produce functional electro anatomic maps of the heart, optimized to show areas of CFAE. 1. ICL (Interval Confidence Level) map with 10-40 color scale. 2. Minimum voltage threshold 0.04 mV. 3. Maximum voltage threshold 0.2 mV. 4. Minimum duration 15 ins. 5. Maximum duration 80 ms. Identification of Ganglionated Plexi [00481 The normal locations of ganglionated plexi in the heart are known; however there is anatomic variability among subjects. Moreover, areas of the heart containing the ganglionated plexi are characterized by continuous or intermittent CFAE's. If the number of CFAE's in an area of interest exceeds a predetermined threshold, typically 40, in one approach, ganglionated plexi are presumptively identified. Alternatively, ganglionated plexi may be considered to exist in areas of interest having locally maximal numbers of CFAE segments, irrespective of the actual number of CFAE's. [0049] Optionally, although identification of ganglionated plexi using CFAE mapping as described above, the existence of such ganglionated plexi can be confirmed by applying high-frequency electrical stimulation to areas presumptively containing ganglionated plexi, using a bipolar electrode probe. Stimulation at 20 Hz, 12 volts, with a pulse width of 10 ms is suitable. If such areas indeed are sites of ganglionated plexi, the response to the stimulation should be one or more of the following cardiovascular effects, which mimic vagal stimulation: reduction in blood pressure; reduction in sinus rate; or asystole lasting for a few cycles. Any of these responses is considered to confirm the presence of ganglionated plexi at the current 1 8 /0 7 /13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc, 14 - 15 site of stimulation. If the effects are not observed, then it is concluded that ganglionated plexi are not confirmed to be present. Electrical Mapping of Ganglionated Plexi and CFAE's [0050] Functional electro-anatomic maps may be generated, for example using the above-noted CARTO XP EP Navigation and Ablation System, to display the associations of ganglionated plexi and CFAE complexes on a functional electroanatomical map. Reference is now made to Fig. 4 and Fig. 5, which are functional electroanatomical maps in the postero-anterior and right anterior oblique projections, respectively, showing CFAE's and ganglionated plexi, in accordance with a disclosed embodiment of the invention. In Fig. 4 regions 61, 63, 65 typify areas containing ganglionated plexi (shown as circles 66), and are located within larger areas 67, 69, having relatively large number of CFAE's. The larger areas 67, 69 are demarcated by broken lines. Area 67 is an infero-posterior area having large numbers of CFAE's. Area 67 contains the inferior left and inferior right ganglionated plexi in region 63 and region 61, respectively. Area 69, in the superior left portion, has large numbers of CFAE's, and includes the superior left ganglionated plexi. In Fig. 5, area 71 is a large area in the anterior right portion, and includes the anterior right ganglionated plexi in region 73. Area 75, in the superior left portion of the atrium, includes region 77 in which the superior left ganglionated plexi are located. To assist with orientation, the following structures are shown: left superior pulmonary vein 79, left inferior pulmonary vein 81, right inferior pulmonary vein 83, and right superior pulmonary vein 85. The mitral annulus occupies area 89. A key 87 encodes the number of CFAE's in any given area. [00511 Once the CFAE's and ganglionated plexi are located, ablative therapy may be performed if indicated. [0052] It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and sub-combinations of the various features described hereinabove, as well as 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,15 - 16 variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description. [0053] Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" and "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps. [00541 The reference to any prior art in this specification is not, and should not be taken as, an acknowledgment or any form or suggestion that the prior art forms part of the common general knowledge in Australia. 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,16
Claims (14)
1. A method for mapping abnormal electrical activity in a heart of a living subject, comprising the steps of: obtaining electrical signal data from respective locations of the heart in an area of interest; automatically analyzing the signal data to identify complex fractionated electrograms or complex fractionated electrogram segments therein; determining if the number of identified complex fractionated electrograms in the area of interest exceed a predetermined threshold for complex fractionated electrograms or if the number of complex fractionated electrogram segments in the area of interest achieve a maximal number; identifying one or more of the locations in the area of interest as having ganglionated plexi if the number of identified complex fractionated electrograms in the area of interest exceeded the predetermined threshold for complex fractionated electrograms or if the number of complex fractionated electrogram segments in the area of interest achieved the maximal number; deriving an electroanatomic map of the heart from the signal data that includes a spatial distribution of the complex fractionated electrograms and the ganglionated plexi, the electroanatomical map including a key encoding the number of complex fractionated electrograms in any area of interest; and displaying the spatial distribution of the complex fractionated electrograms and the ganglionated plexi with the key encoding the number of complex fractionated electrograms in any area of interest of the electroanatomic map.
2. The method according to claim 1, wherein identifying one or more of the locations comprises determining that a number of the complex fractionated electrograms at the one or more of the locations complies with a predefined criterion.
3. The method according to claim 2, wherein compliance with the predefined criterion comprises identifying ones of the locations wherein the complex fractionated electrograms exceed a threshold number. 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,17 - 18
4. The method according to claim 2, wherein compliance with the predefined criterion comprises identifying ones of the locations having locally maximal numbers of complex fractionated electrograms.
5. The method according to any one of the preceding claims, further comprising the steps of: electrically stimulating a selected one of the locations that presumptively contain ganglionated plexi; recording responsively to the step of electrically stimulating a cardiovascular response comprising at least one of a reduction in sinus rate, a reduction in blood pressure, and a period of asystole; and thereafter reporting a confirmation of a presence of the ganglionated plexi in the selected one of the locations.
6. The method according to any one of the preceding claims, wherein deriving an electroanatomic map comprises coding the electroanatomic map according to numbers of the complex fractionated electrograms detected in the respective locations.
7. An apparatus for mapping electrical activity in a heart of a living subject, comprising: a memory for storing electrical signal data from respective locations in an area of interest of the heart; a processor configured to access the memory and automatically analyze the signal data to identify complex fractionated electrograms or complex fractionated electrogram segments in the area of interest, and to determine when the number of identified complex fractionated electrograms in the area of interest exceed a predetermined threshold for complex fractionated electrograms or when the number of complex fractionated electrogram segments in the area of interest achieve a maximal number, and identify one or more of the area of interests as having ganglionated plexi when the number of identified complex fractionated electrograms in the area of interest exceeded the predetermined threshold for complex fractionated 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,18 -19 electrograms or when the number of complex fractionated electrogram segments in the area of interest achieved the maximal number; an electroanatomic map of the heart is derived from the signal data that includes a spatial distribution of the complex fractionated electrograms and the ganglionated plexi, the electroanatomical map including a key encoding the number of complex fractionated electrograms in any area of interest; and a display for presenting the electroanatomic map to an operator.
8. The apparatus according to claim 7, wherein the processor is operative to identify one or more of the locations by determining that a number of the complex fractionated electrograms at the one or more of the locations complies with a predefined criterion.
9. The apparatus according to claim 8, wherein compliance with the predefined criterion comprises an identification of ones of the locations wherein the complex fractionated electrograms exceed a threshold number.
10. The apparatus according to claim 8, wherein compliance with the predefined criterion comprises an identification of ones of the locations having locally maximal numbers of complex fractionated electrograms.
11. The apparatus according to any one of claims 7 to 10, wherein the processor is operative to record responsively to an electrical stimulation of selected ones of the locations a cardiovascular response comprising at least one of a reduction in sinus rate, a reduction in blood pressure, and a period of asystole; and thereafter report a confirmation of a presence of the ganglionated plexi in the selected ones of the locations.
12. The apparatus according to any one of claims 7 to 11, wherein the processor is operative to code the electroanatomic map according to numbers of the complex fractionated electrograms detected in the respective locations. 18/07/13,M\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,19 -20
13. A method for mapping abnormal electrical activity in a heart of a living subject, substantially as hereinbefore described with reference to the accompanying drawings.
14. An apparatus for mapping electrical activity in a heart of a living subject, substantially as hereinbefore described with reference to the accompanying drawings. 18/07/13,M:\Graham\Clare\Speci & Amndmts\17649 Speci.Doc,20
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US99096107P | 2007-11-29 | 2007-11-29 | |
US60/990,961 | 2007-11-29 | ||
US12/275,380 | 2008-11-21 | ||
US12/275,380 US8359092B2 (en) | 2007-11-29 | 2008-11-21 | Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram |
Publications (2)
Publication Number | Publication Date |
---|---|
AU2008249243A1 AU2008249243A1 (en) | 2009-06-18 |
AU2008249243B2 true AU2008249243B2 (en) | 2013-09-19 |
Family
ID=40286311
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
AU2008249243A Ceased AU2008249243B2 (en) | 2007-11-29 | 2008-11-27 | Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram |
Country Status (10)
Country | Link |
---|---|
US (1) | US8359092B2 (en) |
EP (1) | EP2064990A1 (en) |
JP (1) | JP5323458B2 (en) |
KR (1) | KR101496739B1 (en) |
CN (1) | CN101558993B (en) |
AU (1) | AU2008249243B2 (en) |
BR (1) | BRPI0804931A2 (en) |
CA (1) | CA2644884C (en) |
IL (1) | IL195589A (en) |
MX (1) | MX2008015362A (en) |
Families Citing this family (53)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9750425B2 (en) * | 2004-03-23 | 2017-09-05 | Dune Medical Devices Ltd. | Graphical user interfaces (GUI), methods and apparatus for data presentation |
US20110230775A1 (en) * | 2008-11-24 | 2011-09-22 | Koninklijke Philips Electronics N.V. | Imaging apparatus for imaging a heart |
JP5786108B2 (en) | 2009-05-08 | 2015-09-30 | セント・ジュード・メディカル・ルクセンブルク・ホールディング・エスエーアールエル | Method and apparatus for controlling lesion size in catheter ablation therapy |
US9393068B1 (en) | 2009-05-08 | 2016-07-19 | St. Jude Medical International Holding S.À R.L. | Method for predicting the probability of steam pop in RF ablation therapy |
US8926605B2 (en) | 2012-02-07 | 2015-01-06 | Advanced Cardiac Therapeutics, Inc. | Systems and methods for radiometrically measuring temperature during tissue ablation |
US9226791B2 (en) | 2012-03-12 | 2016-01-05 | Advanced Cardiac Therapeutics, Inc. | Systems for temperature-controlled ablation using radiometric feedback |
US8954161B2 (en) | 2012-06-01 | 2015-02-10 | Advanced Cardiac Therapeutics, Inc. | Systems and methods for radiometrically measuring temperature and detecting tissue contact prior to and during tissue ablation |
US9277961B2 (en) | 2009-06-12 | 2016-03-08 | Advanced Cardiac Therapeutics, Inc. | Systems and methods of radiometrically determining a hot-spot temperature of tissue being treated |
CN102686252B (en) * | 2009-12-28 | 2017-01-11 | 甘布罗伦迪亚股份公司 | Apparatus and method for prediction of rapid symptomatic blood pressure decrease |
WO2012047563A1 (en) * | 2010-09-27 | 2012-04-12 | Bailin Steven J | Method for determining the location of regions in tissue relevant to electrical propagation |
US8340766B2 (en) * | 2010-10-07 | 2012-12-25 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Method and system for identifying cardiac arrhythmia driver sites |
US9149327B2 (en) | 2010-12-27 | 2015-10-06 | St. Jude Medical Luxembourg Holding S.À.R.L. | Prediction of atrial wall electrical reconnection based on contact force measured during RF ablation |
CN105662421B (en) * | 2010-12-27 | 2019-04-19 | 圣犹达医疗用品卢森堡控股有限公司 | Join prediction technique again based on the atrial wall electricity for measuring contact force in radiofrequency ablation procedures |
BR112013020718A2 (en) * | 2011-02-17 | 2016-10-18 | Koninkl Philips Nv | computer system, method and program for providing a map of the electrical activity of the heart of a living being by means of electrical heart signals acquired through a plurality of surface electrodes on an outer surface of the living being |
US9101333B2 (en) | 2011-11-14 | 2015-08-11 | Biosense Webster (Israel) Ltd. | Integrative atrial fibrillation ablation |
US10456196B2 (en) | 2011-12-15 | 2019-10-29 | Biosense Webster (Israel) Ltd. | Monitoring and tracking bipolar ablation |
US20130241929A1 (en) * | 2012-03-13 | 2013-09-19 | Fady Massarwa | Selectably transparent electrophysiology map |
US8676305B2 (en) * | 2012-03-21 | 2014-03-18 | Biosense Webster (Israel) Ltd. | Automated analysis of complex fractionated electrograms |
EP2863793A1 (en) | 2012-06-20 | 2015-04-29 | Boston Scientific Scimed, Inc. | Far-field vs local activation discrimination on multi-electrode egms using vector analysis in multi-dimensional signal space |
US10182745B2 (en) | 2012-06-22 | 2019-01-22 | Koninklijke Philips N.V. | Cavity determination apparatus |
KR101432368B1 (en) * | 2012-09-07 | 2014-08-20 | 연세대학교 산학협력단 | System and method for generating pseudo electrogram |
US9681817B2 (en) | 2012-12-20 | 2017-06-20 | Boston Scientific Scimed, Inc. | Suppression of global activation signals during anatomical mapping |
US9439578B2 (en) | 2012-12-27 | 2016-09-13 | Boston Scientific Scimed, Inc. | Artifact cancellation to suppress far-field activation during electrophysiology mapping |
US11229362B2 (en) * | 2013-01-24 | 2022-01-25 | Tylerton International Holdings Inc. | Body structure imaging |
CN105163657A (en) * | 2013-03-11 | 2015-12-16 | 泰勒顿国际控股公司 | Modeling the autonomous nervous system and uses thereof |
US20160220835A1 (en) | 2013-09-08 | 2016-08-04 | Tylerton International Inc. | Apparatus and methods for diagnosis and treatment of patterns of nervous system activity affecting disease |
WO2015066112A1 (en) | 2013-10-30 | 2015-05-07 | St. Jude Medical, Cardiology Division, Inc. | Cardiac mapping system and method for voltage-based evaluation of electrograms |
JP6300911B2 (en) | 2013-10-30 | 2018-03-28 | セント・ジュード・メディカル,カーディオロジー・ディヴィジョン,インコーポレイテッド | System and method for cardiac mapping for bidirectional activation detection of electrograms |
US10646183B2 (en) | 2014-01-10 | 2020-05-12 | Tylerton International Inc. | Detection of scar and fibrous cardiac zones |
EP3151729A1 (en) | 2014-06-03 | 2017-04-12 | Boston Scientific Scimed, Inc. | Medical devices for mapping cardiac tissue |
WO2016016839A1 (en) | 2014-07-30 | 2016-02-04 | Navix International Limited | Registering nuclear medicine data |
WO2016033504A1 (en) * | 2014-08-29 | 2016-03-03 | Cardioinsight Technologies, Inc. | Signal characterization to facilitate therapy delivery |
WO2016081611A1 (en) | 2014-11-19 | 2016-05-26 | Advanced Cardiac Therapeutics, Inc. | High-resolution mapping of tissue with pacing |
JP6725178B2 (en) | 2014-11-19 | 2020-07-15 | エピックス セラピューティクス,インコーポレイテッド | Ablation apparatus, systems and methods using high resolution electrode assemblies |
CA2967829A1 (en) | 2014-11-19 | 2016-05-26 | Advanced Cardiac Therapeutics, Inc. | Systems and methods for high-resolution mapping of tissue |
US9833161B2 (en) * | 2015-02-09 | 2017-12-05 | Biosense Webster (Israel) Ltd. | Basket catheter with far-field electrode |
US9636164B2 (en) | 2015-03-25 | 2017-05-02 | Advanced Cardiac Therapeutics, Inc. | Contact sensing systems and methods |
WO2017160808A1 (en) | 2016-03-15 | 2017-09-21 | Advanced Cardiac Therapeutics, Inc. | Improved devices, systems and methods for irrigated ablation |
US10349855B2 (en) * | 2016-06-10 | 2019-07-16 | Biosense Webster (Israel) Ltd. | Identification and visualization of cardiac activation sequence in multi-channel recordings |
WO2018195052A1 (en) * | 2017-04-18 | 2018-10-25 | Boston Scientific Scimed Inc. | Annotation histogram for electrophysiological signals |
CN110809448B (en) | 2017-04-27 | 2022-11-25 | Epix疗法公司 | Determining properties of contact between catheter tip and tissue |
US10918310B2 (en) * | 2018-01-03 | 2021-02-16 | Biosense Webster (Israel) Ltd. | Fast anatomical mapping (FAM) using volume filling |
IL272254B2 (en) | 2019-02-15 | 2023-04-01 | Biosense Webster Israel Ltd | Transesophageal catheter with carbon dioxide delivery system for thermal protection of esophagus |
US10905349B1 (en) | 2019-07-16 | 2021-02-02 | Biosense Webster (Israel) Ltd. | Mapping atrial fibrillation using fragmentation index |
US11844616B2 (en) * | 2019-08-13 | 2023-12-19 | Biosense Webster (Israel) Ltd. | Enhanced visualization of organ electrical activity |
US20210187242A1 (en) | 2019-12-23 | 2021-06-24 | Ethicon, Inc. | Fluid Delivery System for Creating Separation Between Biological Surfaces |
US20210186601A1 (en) | 2019-12-23 | 2021-06-24 | Ethicon, Inc. | Transesophageal Catheter for Thermal Protection of the Esophagus |
US20210186642A1 (en) | 2019-12-23 | 2021-06-24 | Ethicon, Inc. | Esophageal Protection Pathways |
US11160485B2 (en) | 2020-04-01 | 2021-11-02 | Biosense Webster (Israel) Ltd. | Propagation map of a heart chamber with areas demonstrating fractionated electrograms |
US11478182B2 (en) * | 2021-01-07 | 2022-10-25 | Biosense Webster (Israel) Ltd. | Incorporating a confidence level into an electrophysiological (EP) map |
WO2022264011A1 (en) | 2021-06-14 | 2022-12-22 | Ethicon, Inc. | Catheter with carbon dioxide delivery system and methods |
US11969255B2 (en) | 2021-12-12 | 2024-04-30 | Biosense Webster (Israel) Ltd. | Detection of fractionated signals in stable arrhythmias |
CN117297576B (en) * | 2023-11-30 | 2024-02-13 | 四川锦江电子医疗器械科技股份有限公司 | Device for positioning and ablating cardiac vagus plexus |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5483968A (en) * | 1991-06-25 | 1996-01-16 | Technion Research And Development Foundation Ltd. | Method and apparatus for analyzing the electrical activity of the heart |
Family Cites Families (24)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1994006349A1 (en) * | 1992-09-23 | 1994-03-31 | Endocardial Therapeutics, Inc. | Endocardial mapping system |
US5391199A (en) | 1993-07-20 | 1995-02-21 | Biosense, Inc. | Apparatus and method for treating cardiac arrhythmias |
US5738096A (en) | 1993-07-20 | 1998-04-14 | Biosense, Inc. | Cardiac electromechanics |
ATE253864T1 (en) | 1994-08-19 | 2003-11-15 | Biosense Inc | MEDICAL DIAGNOSIS, TREATMENT AND DISPLAY SYSTEM |
US6690963B2 (en) | 1995-01-24 | 2004-02-10 | Biosense, Inc. | System for determining the location and orientation of an invasive medical instrument |
JP4786613B2 (en) | 1996-01-08 | 2011-10-05 | バイオセンス・ウエブスター・インコーポレーテツド | Heart electromechanical technology |
AU709081B2 (en) | 1996-02-15 | 1999-08-19 | Biosense, Inc. | Medical procedures and apparatus using intrabody probes |
ES2210498T3 (en) | 1996-02-15 | 2004-07-01 | Biosense, Inc. | POSITIONABLE TRANSDUCERS INDEPENDENTLY FOR LOCATION SYSTEM. |
US6047214A (en) * | 1998-06-09 | 2000-04-04 | North Carolina State University | System and method for powering, controlling, and communicating with multiple inductively-powered devices |
US7263397B2 (en) * | 1998-06-30 | 2007-08-28 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Method and apparatus for catheter navigation and location and mapping in the heart |
US6226542B1 (en) | 1998-07-24 | 2001-05-01 | Biosense, Inc. | Three-dimensional reconstruction of intrabody organs |
US6301496B1 (en) | 1998-07-24 | 2001-10-09 | Biosense, Inc. | Vector mapping of three-dimensionally reconstructed intrabody organs and method of display |
US6892091B1 (en) | 2000-02-18 | 2005-05-10 | Biosense, Inc. | Catheter, method and apparatus for generating an electrical map of a chamber of the heart |
US6669692B1 (en) | 2000-08-21 | 2003-12-30 | Biosense Webster, Inc. | Ablation catheter with cooled linear electrode |
US7729742B2 (en) | 2001-12-21 | 2010-06-01 | Biosense, Inc. | Wireless position sensor |
US20040068178A1 (en) | 2002-09-17 | 2004-04-08 | Assaf Govari | High-gradient recursive locating system |
US7306593B2 (en) | 2002-10-21 | 2007-12-11 | Biosense, Inc. | Prediction and assessment of ablation of cardiac tissue |
US7001383B2 (en) * | 2002-10-21 | 2006-02-21 | Biosense, Inc. | Real-time monitoring and mapping of ablation lesion formation in the heart |
US7156816B2 (en) | 2002-11-26 | 2007-01-02 | Biosense, Inc. | Ultrasound pulmonary vein isolation |
US7397364B2 (en) | 2003-11-11 | 2008-07-08 | Biosense Webster, Inc. | Digital wireless position sensor |
US9861836B2 (en) * | 2005-06-16 | 2018-01-09 | Biosense Webster, Inc. | Less invasive methods for ablation of fat pads |
US8229545B2 (en) | 2005-09-15 | 2012-07-24 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for mapping complex fractionated electrogram information |
US9629567B2 (en) | 2006-01-12 | 2017-04-25 | Biosense Webster, Inc. | Mapping of complex fractionated atrial electrogram |
US7774051B2 (en) * | 2006-05-17 | 2010-08-10 | St. Jude Medical, Atrial Fibrillation Division, Inc. | System and method for mapping electrophysiology information onto complex geometry |
-
2008
- 2008-11-21 US US12/275,380 patent/US8359092B2/en active Active
- 2008-11-26 CA CA2644884A patent/CA2644884C/en active Active
- 2008-11-27 IL IL195589A patent/IL195589A/en active IP Right Grant
- 2008-11-27 AU AU2008249243A patent/AU2008249243B2/en not_active Ceased
- 2008-11-28 EP EP08253842A patent/EP2064990A1/en not_active Withdrawn
- 2008-11-28 BR BRPI0804931-9A patent/BRPI0804931A2/en not_active Application Discontinuation
- 2008-11-28 CN CN200810209891.6A patent/CN101558993B/en active Active
- 2008-11-28 JP JP2008303839A patent/JP5323458B2/en active Active
- 2008-11-28 KR KR20080119270A patent/KR101496739B1/en not_active IP Right Cessation
- 2008-12-01 MX MX2008015362A patent/MX2008015362A/en not_active Application Discontinuation
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5483968A (en) * | 1991-06-25 | 1996-01-16 | Technion Research And Development Foundation Ltd. | Method and apparatus for analyzing the electrical activity of the heart |
Non-Patent Citations (2)
Title |
---|
LEMERY et al.,'Feasibility Study Of Endocardial Mapping Of Ganglionated Plexuses During Catheter Ablation Of Atrial Fibrillation', Heart Rhythm, April 2006, Vol 3, No 4, pages 387-396 * |
NAKAGAWA et al., 'Oral Abstracts Session, Abstract AB 33-6: Effective Localization Of Left Atrial Autonomic Ganglionated Plexi Using A Computer Algorithm During Mapping In Atrial Fibrillation', Heart Rhythm, May 2007, Vol 4, No 5, pages S71 * |
Also Published As
Publication number | Publication date |
---|---|
US8359092B2 (en) | 2013-01-22 |
JP5323458B2 (en) | 2013-10-23 |
IL195589A (en) | 2013-07-31 |
US20090192393A1 (en) | 2009-07-30 |
CN101558993A (en) | 2009-10-21 |
CA2644884C (en) | 2015-01-20 |
EP2064990A1 (en) | 2009-06-03 |
JP2009183687A (en) | 2009-08-20 |
AU2008249243A1 (en) | 2009-06-18 |
CN101558993B (en) | 2015-10-07 |
IL195589A0 (en) | 2009-09-01 |
CA2644884A1 (en) | 2009-05-29 |
MX2008015362A (en) | 2009-05-28 |
KR101496739B1 (en) | 2015-02-27 |
KR20090056871A (en) | 2009-06-03 |
BRPI0804931A2 (en) | 2009-07-28 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
AU2008249243B2 (en) | Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram | |
US9629567B2 (en) | Mapping of complex fractionated atrial electrogram | |
JP6441007B2 (en) | Medical device for mapping ventricular / atrial premature contractions during sinus rhythm | |
AU2013200007B2 (en) | Contact assessment based on phase measurement | |
JP5649573B2 (en) | Detection device for detecting an object | |
JP6752571B2 (en) | Long-range field insensitive device with catheter electrodes | |
US10682175B2 (en) | Using catheter position and temperature measurement to detect movement from ablation point | |
JP2005131367A (en) | Transient event mapping in heart | |
AU2012261575A1 (en) | Monitoring and tracking bipolar ablation | |
JP2020507395A (en) | Methods and systems for determining the prevalence of Cardiac phenomena | |
US11553867B2 (en) | Systems and methods for displaying EP maps using confidence metrics | |
US20200397329A1 (en) | Methods and systems for transmural tissue mapping |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
FGA | Letters patent sealed or granted (standard patent) |